MSK Pediatric Orthopedic Conditions Flashcards

1
Q

Thigh-foot angle

How to measure/what is it

A

Angle between axis of foot and axis of thigh measured with child prone and knees at 90 flexion —> describes degrees of TIBIAL torsion

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2
Q

3 causes of toeing-in

A

Metatarsus adductus
Internal tibial torsion
Increased femoral anteversion

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3
Q

What is metatarsus adductus, what are the 2 types

A

most common congenital foot deformity

1) rigid: medial subluxation of TMT it’s hindfoot slightly in valgus, navicular lateral to head of talus
2) flexible: adduction of all 5 metatarsals at TMT joint

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4
Q

What is surgical option for flexible metatarsus adductus

A

Release of abductor hallucinations tendon

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5
Q

Femoral anteversion is excessive if (degrees)

A

> 25 from frontal plane

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6
Q

Femoral retroversion is excessive if (degrees)

A

<10 from frontal plane

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7
Q

Toeing out is caused by

A

Femoral retroversion, external tibial torsion, flat feet

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8
Q
Talipes equinovarus (aka \_\_\_\_) occurs from what?
What does deformity look like?
A

Clubfoot- postural rom intrauterine malposition
Abnormal dev of talar head/neck
Observation: PF, addicted, inverted foot (postural)

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9
Q

PT Tx for postural talipes equinovarus

A
  • manipulation followed by casting/splinting (Ponseti method)
  • following casting, stretching
  • Denis-Browne splint orthoses throughout day for 3 months, at night up to 3 years
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10
Q

Tx for Talipes equinovarus NON-postural

A

Surgical intervention followed by casting/splinting

Achilles tenotomy may be needed

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11
Q

Genu ___ is normal in newborn and infants

A

Varum

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12
Q

Maximal varum present at ____ (age)

A

6-12 months

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13
Q

Lower limbs begin to straighten with zero tibiofemoral angle by ______ (age)

A

18-24 months

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14
Q

Knees gradually drift into valgus and is maximal around ____ (age) with average medial tibiofemoral angle of ____ degrees

A

3-4 yrs

12 degrees

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15
Q

Genu valgum spontaneously corrects by age ___ to adult alignment of lower limbs

A

7 yrs

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16
Q

__ of valgum in females and ___ in males (degrees)

17
Q

Hip Dysplasia Risk Factors

A
females > males
Breech position
Family history
Low levels of amniotic fluid
Swaddling infant too tight
18
Q

Hip dysplasia clinical exam (5)

A
Ortolani test
Barlow test
Klisic sign
Galeazzi sign
Limited hip abduction
19
Q

Hip dysplasia tx

A

1) Pavlik harness is gold standard- Maintains hip in flexion and abduction to keep head of femur in acetabulum (newborn-6mo)
2) Closed reduction under anesthesia followed by SPICA cast for 12 weeks for children 6 mo-2 yrs
3) Open reduction under anesthesia followed by spica cas 6-12 wks for children >2yrs

20
Q

Transient synovitis- what is it? What are s/sx?

A

Acute onset of hip pain children 3-10 yrs old, transient inflammation of synovium of hip
1) U/L hip/groin pain 2) med thigh/knee pain 3) crying at night 4) antalgic limp 5) pain not common 6) recent upper respiratory tract infection

Lasts 7-10 days

21
Q

What is legg-calve perthes disease? Age/male vs female?

A

Interruption of blood supply to femoral head

2-13 yo, 4x greater incidence males > females

22
Q

Dx test and result for legg-calve perthes disease

A

MRI showing positiv bony crescent sign

23
Q

Clinical exam findings for legg-calve perthes disease and tx

A
  1. Characteristic psoatic limp due to psoas weakness, moves in ER/flexion/adduction
  2. Gradual onset hip/thigh/knee aching
  3. AROM limited in abduction and extension

Tx: cast 4-6 weeks, surgery if necessary

24
Q

SCFE - what is it, how old, male vs female, limitations seen

A
fem head displaced posterior/inferior
Males 10-17 yo, females 8-15 yo
Males 2x > females
AROM limited flexion, abduction, IR
vague hip/thigh/knee pain (maybe trendelenburg gait)
Requires ORIF
25
Tendon lengthening conditions
Osgood-schlatter disease Sever’s disease Sinding-Larsen Johannson’s disease
26
What is Sinding-Larsen Johannson’s Disease
Traction apophysitis at patella-patellar tendon junction
27
Osteochondritis dessicans
Separation of articular cartilage from underlying bone (usually medial femoral condyle) -Osteochondral bone fragment becomes detached from articular surface forming loose bod in joint
28
Panner’s disease
Localized AVN of capitellum leading to loss of subchondral bone with fissuring and softening of articular surfaces of radiocapitellar joint (children 10 and younger)
29
``` Pes planus (flat foot) Normal in infant and toddler feet and develop normal arches around ____ (age) ```
2-3 years
30
Pes planus leads to decreased ability of foot to provide _____ ____ for push off during gait
Rigid lever
31
Structural vs non-structural scoliosis
Structural: irreversible lateral curve with rotational component Non-structural: reversible lateral curve without rotational component and straightens with flexion of spine
32
Tx for scoliosis (conservative, bracing, surgery)
Conservative: <25 degree curve Bracing: 25-45 degree curve Surgery with Harrington rod: >45 degree curve
33
Scoliosis direction named for (convex/concave)
CONCAVITY
34
Arthrogryposis multiplex congenita
Congenital deformity of skeleton and soft tissues, characterized by limitation in joint motion and “sausage like” appearance of limbs 1. Non-progressive contractures 2. Intelligence develops normally
35
OI inherited disorder transmitted by
Autosomal dominant gene
36
What is OI
1. Abnormal collagen synthesis — imbalance between bone deposition and reabsorption 2. Cortical and cancellous bones become very thin —> fractures/deformity
37
Spondylolisthesis
Congenitally defective pars interarticularis | Anterior or posterior slippage of one vertebra on another following bilateral fx of pars
38
Spondylolysthesis grades
1 (25% slippage) to 4 (100% slippage)
39
Spondylolysis
Fx of pars with positive “Scotty dog” on oblique x-ray of spine